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De Martino's Concept of Critical Ethnocentrism and Its Relevance To Transcultural Psychiatry 50(1) 6–20 ! The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1363461513475928 tps.sagepub.com Article De Martino’s concept of critical ethnocentrism and its relevance to transcultural psychiatry Giovanni Stanghellini ‘‘G. D’Annunzio’’ University of Chieti-Pescara and Universidad ‘‘Diego Portales’’ Raffaella Ciglia ‘‘G. D’Annunzio’’ University of Chieti-Pescara Abstract Ethnography and hermeneutics help us think of the clinical encounter as a meeting of cultures. In this paper, we examine Ernesto De Martino’s concept of critical ethnocentrism and its relevance for psychiatry, arguing for the necessity of a cultural self-assessment on the part of the clinician as a means of optimizing analyses of the patient’s culture. Conceptualizing the clinician as an ‘‘ethnologist,’’ we argue that clinicians should be able to describe and acknowledge patients’ cultural backgrounds, while remaining aware of their own culturally rooted prejudices. Focusing on the case of persons affected by schizophrenia, we suggest that De Martino’s work invites an openness to hermeneutic dialogue that aims for the coconstruction of shared narratives by clinician and patient. Keywords critical ethnocentrism, culture, De Martino, hermeneutics, psychopathology, schizophrenia The idea that the clinical encounter in the mental health field is a hermeneutic one, or a meeting of cultures, is not new (see e.g., Atwood & Stolorow 1984; Frank, 1973; Frankl, 1984). Indeed, this follows from the more general claim that every encounter between persons is also a meeting between the different horizons of historically determined meanings in which these persons are Corresponding author: Giovanni Stanghellini, Department of Biomedical Sciences, G. D’Annunzio University, Via dei Vestini, Chieti 66013, Italy. Email: [email protected] Downloaded from tps.sagepub.com at Circolo Giuridico on August 31, 2016 Stanghellini and Ciglia 7 embedded (Gadamer, 1960). In this paper, we develop this idea, drawing on the work of Ernesto De Martino, an Italian philosopher, anthropologist, and psy- chopathologist. De Martino’s work lies at the juncture of psychiatry, anthropol- ogy, and philosophy (Charuty, 2010; Gallini, 2005; Gallini & Massenzio, 1997) and offers a useful heuristic for transcultural psychiatry (Bartocci & Prince, 1998; Beneduce & Martelli, 2005). We examine De Martino’s concept of critical ethno- centrism and its relevance for psychiatry, arguing for the necessity of a cultural self- assessment on the part of the clinician as a means of optimizing analyses of the culture embodied by patients affected by mental disorders—especially schizophre- nia. Conceptualizing the clinician as an ‘‘ethnologist,’’ we argue that he should be able to describe and acknowledge his patients’ cultural background, while remain- ing aware of his own culturally rooted prejudices. We suggest that De Martino’s work invites an openness to hermeneutic dialogue that aims for the coconstruction of shared narratives by clinician and patient. In what follows, we discuss De Martino’s work, with the aim of developing a methodology of the clinical encounter. We begin with De Martino’s concept of ‘‘culture’’ as the valorization of the intersubjective dimension that allows for the sharing of a common world. This is followed by a consideration of the theory of the ethnographic encounter and the perspective of critical ethnocentrism as a desirable point of view that fosters openness towards other cultures and, simultaneously, the acquisition of greater knowledge of one’s own culture. The discussion then turns to the clinic. We present De Martino’s conceptualization of mental illness and of phenomenological psychopathology. In concluding, we argue for the clinical application of critical ethnocentrism based on the perspective of clinical hermeneutics, especially in work with persons affected by schizophrenia. De Martino on culture According to De Martino, culture is the moral energy that allows a person to separate himself from the merely natural, in order to found a human world (De Martino, 1977, p. 659). It is an individual ‘‘initiative which is consolidated in a tradition, a tradition that conditions and feeds that same individual initiative in a circularity’’ (De Martino, 1948, p. 121). In fact, the initiative of the individual takes place inside of a ‘‘cultural homeland’’—a concept that has much in common with Husserl’s notion of ‘‘homeworld’’ (Husserl, 1973), the sphere in which we feel at home and at ease. One’s cultural homeland is shared with other members of the community—it is not a world of a single individual, rather an intersubjective world of tradition, religion, myth, collective values, etc. (Luft, 1998; see also Cherchi, 1996). Every culture is called upon to intersubjectively resolve the problem of separation from nature (De Martino, 1977, p. 175). De Martino calls the moral impetus that regulates this separation the ‘‘ethos of transcendence.’’ The ethos of transcendence is a kind of fundamental human moral drive defined by De Martino (1977) as an e´lan moral (that has much in common with Levinas’ [1979] concept of Downloaded from tps.sagepub.com at Circolo Giuridico on August 31, 2016 8 Transcultural Psychiatry 50(1) ‘‘transcendence’’), a ‘‘primordial force’’ that makes community possible because it is founded on intersubjectively shared values. Although its content varies from one cultural setting to another, the ethos of transcendence represents both a vital impetus and a moral principle that mediates the passage from nature to cultural institutions and sustains the structure of those institutions once they have been built. Therefore, from a De Martinian perspective, ‘‘being-in-the-world’’ means to have to be in the world by giving value to the things of life—a value that is realized intersubjectively in culture. If there is to be a world, and a way for the individual to be situated in that world, it is necessary that we not coincide immediately with the situation but that we be separated from it. The parameters that maintain the distance established through this separation are called values and they are culturally conditioned (De Martino, 1977, p. 674). In every culture there is the chance that this ethos of transcendence may collapse, and so life in a culturally significant world is always exposed to the risk of not being able to be in any culturally possible world. Specifically, for De Martino mental illness represents the ‘‘permanent anthropological possibility’’ (De Martino, 1977, p. 669) of this risk. Culture, then, constitutes a ‘‘solemn exorcism’’ against the risk of mental illness (De Martino, 1977, p. 669). Cultural encounters and critical ethnocentrism For De Martino, ethnology is the critical comparison of the histories of ethnic groups, beginning with the history of Western culture as point of reference (De Martino, 1977, p. 5). The fundamental methodological problem of the ethnologist is to acknowledge the inevitable contradiction of having to understand and evalu- ate a cultural system which is not one’s own, making the effort to understand and evaluate it according to ‘‘objective’’ criteria. Ethnographic travel leads one to sys- tems of cultural choice that are different from one’s own, different from those in which one was born and raised (De Martino, 1961). Therefore, ethnographic travel provides an opportunity for self-analysis: one retraces the formative process of one’s own culture critically, questioning the genesis and evolution of its cultural institutions. The ethnographic encounter permits us to gain access to ‘‘other ways of being human that go beyond the awareness the West has of being human’’ while also revealing to us what it means ‘‘to be human’’ within Western culture (De Martino, 1977, p. 391). De Martino criticizes the long-held distinction between Western civilization and ‘‘non-Westernized humanity’’ and maintains that we are instead witnessing a shortening of distances, an increase in intercultural encounters, and a mixing of traditions that undercut this distinction. Ethnography is called upon to develop a ‘‘critical consciousness’’ (De Martino, 1962, p. 90), involving a shift away from its traditional orientation to the study of other cultures, toward a stance that is simultaneously open to other cultural settings, and critical toward its own (De Martino, 1962). Downloaded from tps.sagepub.com at Circolo Giuridico on August 31, 2016 Stanghellini and Ciglia 9 Such a ‘‘double thematization of the self and the other’’ (De Martino, 1977, p. 391) in the ethnographic encounter is accomplished by focusing simultaneously on both one’s own categories of observation and the categories of the foreign culture under observation, thereby arriving at a greater knowledge of the other as well as enhanced self-knowledge. This thematization illuminates the paradox of ethno- graphic observation: in order to observe those from cultures that are not our own, it is necessary to establish categories of observation, but this necessarily results in an ethnocentric distortion of the phenomena that are to be observed. As numerous philosophers have argued, one difficulty in understanding and appre- ciating ‘‘world views’’ that are very different from our own stems from the fact that we view the other’s world with the categories of our own epistemology (see e.g., Pepper, 1942). De Martino indicates how this paradox can be resolved by following a number of steps. First of all, it is necessary from the outset to have an awareness of the ethnocentric limitations of one’s own categories of observation. This means that the history of each of the categories must be explicitly traced. Once one’s own categories have been fully understood by situating them in their historical horizon, they are bracketed, neutralized, in order to allow a sense of the other’s alterity to appear. Through the use of this concept of ‘‘ethnographic epoche´’’ (De Martino, 1977, p. 391), De Martino theorizes a systematic and explicit confrontation between the history of the other culture, as it emerges in certain behaviors, and the Western history sedimented in the categories employed by the ethnologists who are observing and interpreting that behavior.
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